Methods and apparatus for controlling surgical instruments using a surgical port assembly

ABSTRACT

The present disclosure relates to surgical port assemblies including a plurality of inflatable members for applying a force to a portion of a shaft of a surgical instrument which is inserted through an interior space of the surgical port assembly, and to surgical systems including a surgical port assembly, an endoscopic camera, and a control mechanism for controlling inflation and deflation of the plurality of inflatable members of the surgical port assembly.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a U.S. National Stage Application filed under 35U.S.C. § 371(a) of International Patent Application Serial No.PCT/US2015/055226, filed Oct. 13, 2015, which claims the benefit of andpriority to U.S. Provisional Patent Application Ser. No. 62/067,698,filed Oct. 23, 2014, the entire disclosure of which is incorporated byreference herein.

BACKGROUND OF RELATED ART

Surgical techniques and instruments have been developed that allow asurgeon to perform an increasing range of surgical procedures withminimal incisions into the skin and body tissue of a patient.Minimally-invasive surgery has become widely accepted in many medicalspecialties, often replacing traditional open surgery. Unlike opensurgery, which typically requires a relatively large incision,minimally-invasive procedures, such as endoscopy or laparoscopy, areperformed through one or more relatively small incisions.

In laparoscopic and endoscopic surgical procedures, a small “keyhole”incision or puncture is typically made in a patient's body, e.g., in theabdomen, to provide an entry point for a surgical access device which isinserted into the incision and facilitates the insertion of specializedinstruments used in performing surgical procedures within an internalsurgical site. The number of incisions may depend on the type ofsurgery. It is not uncommon for some abdominal operations, e.g.,gallbladder surgery, to be performed through a single incision. In mostpatients, the minimally-invasive approach leads to decreasedpost-operative pain, a shorter hospital stay, a faster recovery,decreased incidence of wound-related and pulmonary complications, costsavings by reducing post-operative care, and, in some cases, a betteroverall outcome.

Minimally-invasive surgical procedures are performed throughout the bodyand generally rely on obtaining access to an internal surgical sitethrough a relatively small pathway, often less than one centimeter indiameter. One method of providing such a pathway is by inserting atrocar assembly through the skin of a patient. Commonly, to place thetrocar assembly, the penetrating tip of the obturator of the trocar ispushed through the skin and underlying tissue until the distal end ofthe cannula is within the body cavity. Alternatively, some trocardevices have a blunt obturator tip for placing the cannula through apreviously-made incision, for example. Once the trocar has been properlypositioned, the obturator is removed and the cannula is then availableas a pathway between the surgical site and the exterior of the patient'sbody through which the surgeon may introduce the various surgicalinstruments required to perform the desired procedures. Surgicalinstruments insertable through a cannula include forceps, clamps,scissors, probes, flexible or rigid scopes, staplers and cuttinginstruments.

In some procedures, a wall of a body cavity is raised by pressurizationof the body cavity to provide sufficient working space at the surgicalworksite and/or to allow a trocar to penetrate the body cavity withoutpenetrating an organ within the cavity. The process of distending theabdomen wall from the organs enclosed in the abdominal cavity isreferred to as insufflation. During a laparoscopic procedure (endoscopyin the abdominal cavity), insufflation may be achieved by introducing aninsufflation gas, such as carbon dioxide, nitrogen, nitrous oxide,helium, argon, or the like, through a Veress needle or other conduitinserted through the abdominal wall, to enlarge the area surrounding thetarget surgical site to create a larger, more accessible work area. Thesurgeon is then able to perform the procedure within the body cavity bymanipulating the instruments that have been extended through thesurgical access device(s). The manipulation of such instruments withinthe internal body is limited by both spatial constraints and the need tomaintain the body cavity in an insufflated state.

In minimally-invasive surgery, the surgeon does not have directvisualization of the surgical field, and thus minimally-invasivetechniques require specialized skills compared to corresponding opensurgical techniques. Although minimally-invasive techniques vary widely,surgeons generally rely on a lighted camera at the tip of an endoscopeto view the surgical site, with a monitor displaying a magnified versionof the site for the surgeon to use as a reference during the surgicalprocedure. The surgeon then performs the surgery while visualizing theprocedure on the monitor. The camera is typically controlled by anassistant to the surgeon. In many instances, the assistant does not playany other role in the procedure other than to hold and direct the cameraso that the surgeon can view the surgical site. The assistant may havedifficulty understanding the surgeon's intent, requiring the surgeoneither to move the camera himself or ask the assistant to redirect thecamera.

Multi-function robotic surgical systems are available with laparoscopiccamera control. In general, robotic surgical systems are large andbulky, requiring a large amount of space around the patient, and havecomplex, time-consuming setups. Extensive training time is typicallyrequired for surgeons to learn to operate the remotely-controlled,camera-toting devices, and additional specialized training is alsotypically required for the entire operating room team. The extremelyhigh initial cost of purchasing a robotic surgical system as well as therelatively high recurring costs of the instruments and maintenance canmake it prohibitive for many hospitals and health-care centers to investin such systems.

SUMMARY

The present disclosure relates to surgical port assemblies including aplurality of inflatable members for applying a force to a portion of ashaft of a surgical instrument which is inserted through an interiorspace of the surgical port assembly, and to surgical systems including asurgical port assembly, an endoscopic camera, and a control mechanismfor controlling inflation and deflation of the plurality of inflatablemembers of the surgical port assembly.

According to an aspect of the present disclosure, surgical port assemblyfor use with surgical instruments, is provided. The surgical portassembly includes a body and a control interface. The body includes anexterior surface and an interior surface. The interior surface definesan interior space, which is configured to allow a surgical instrument topass therethrough. The control interface includes a plurality ofinflatable members coupled to the body and inflatable to selectivelyapply a force to a portion of a shaft of the surgical instrument whenthe shaft is disposed within the interior space. Each of the pluralityof inflatable members is independently selectively inflatable to move adistal portion of the surgical instrument to a desired position

In disclosed embodiments, at least one of the plurality of inflatablemembers is configured to apply a force to the endoscopic instrument in adirection perpendicular to a longitudinal axis of the body.

Additionally, the disclosure includes embodiments where the plurality ofinflatable members includes nine inflatable members. It is furtherdisclosed that the nine inflatable members include a first set of threeaxially-aligned inflatable members, a second set of threeaxially-aligned inflatable members, and a third set of threeaxially-aligned inflatable members. It is further disclosed that thenine inflatable members include a first set of three radially-alignedinflatable members, a second set of three radially-aligned inflatablemembers, and a third set of three radially-aligned inflatable members.

In disclosed embodiments, at least one of the plurality of inflatablemembers includes a friction-enhancing material. It is further disclosedthat a majority of each inflatable member is made from a first material,and that the friction-enhancing material is different from the firstmaterial.

The present disclosure also relates to a surgical system including asurgical port assembly, an endoscopic camera, and a control mechanism.The surgical port assembly includes a body and a control interface. Thebody includes an exterior surface and an interior surface, which definesan interior space configured to allow a surgical instrument to passtherethrough. The control interface includes a plurality of inflatablemembers coupled to the body and inflatable to selectively apply a forceto a portion of a shaft of the surgical instrument when the shaft isdisposed within the interior space. Each of the plurality of inflatablemembers is independently selectively inflatable to move a distal portionof the surgical instrument to a desired position. A portion of theendoscopic camera is positionable within a body cavity and configured toview the distal portion of the endoscopic instrument. The controlmechanism is disposed in operative engagement with the surgical portassembly and the endoscopic camera, and is configured to controlinflation and deflation of the plurality of inflatable members.

It is further disclosed that the control mechanism is configured tocontrol inflation and deflation of each the plurality of inflatablemembers in response to information received from the endoscopic camera.

Embodiments of the system of the present disclosure also include aninflation medium disposed in fluid communication with each of theplurality of inflatable members individually. It is further disclosedthat the inflation medium is disposed in operative communication withthe control mechanism.

In disclosed embodiments of the system, at least one of the plurality ofinflatable members includes a friction-enhancing material. It is furtherdisclosed that a majority of each inflatable member is made from a firstmaterial, and wherein the friction-enhancing material is different fromthe first material.

It is further disclosed that the plurality of inflatable membersincludes nine inflatable members. It is further disclosed that the nineinflatable members include a first set of three axially-alignedinflatable members, a second set of three axially-aligned inflatablemembers, and a third set of three axially-aligned inflatable members.Additionally, it is disclosed that the nine inflatable members include afirst set of three radially-aligned inflatable members, a second set ofthree radially-aligned inflatable members, and a third set of threeradially-aligned inflatable members.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments of the present disclosure are described herein withreference to the accompanying drawings, wherein:

FIG. 1 is a schematic diagram of a system including a port assemblypositioned partially within a patient, a surgical instrument positionedwithin the port assembly, and an endoscopic camera positioned within thepatient, where the port assembly is in communication with the endoscopiccamera, in accordance with embodiments of the present disclosure;

FIG. 2 is a cut-away view of the port assembly of FIG. 1 in accordancewith embodiments of the present disclosure;

FIG. 3 is a top view of the port assembly of FIGS. 1 and 2 in accordancewith embodiments of the present disclosure;

FIG. 4 is a cross-sectional view of the port assembly of the presentdisclosure, taken along line 4-4 of FIG. 3, shown with a surgicalinstrument extending longitudinally through an interior space therein;

FIG. 5 is a cross-sectional view of the port assembly of FIGS. 1-4 shownwith a surgical instrument extending through the interior space of theport assembly at an angle;

FIG. 6 is a schematic illustration of a surgical system in accordancewith the present disclosure;

FIG. 7 is a perspective view of a surgical assembly in accordance withan embodiment of the present disclosure illustrated being attached torobot arms of a robotic surgical system; and

FIG. 8 is an enlarged view of the surgical assembly of FIG. 7, shownextended through a guide ring.

DETAILED DESCRIPTION

Embodiments of the presently disclosed port assemblies, surgicaldevices, and systems are described in detail with reference to thedrawings, in which like reference numerals designate identical orcorresponding elements in each of the several views. As used herein theterm “distal” refers to that portion of the adapter assembly or surgicaldevice, or component thereof, farther from the user, while the term“proximal” refers to that portion of the adapter assembly or surgicaldevice, or component thereof, closer to the user.

A minimally-invasive procedure may be defined as any procedure that isless invasive than open surgery used for the same purpose. As it is usedin this description, “endoscopic surgery” is a general term describing aform of minimally-invasive surgery in which access to a body cavity isachieved through several small percutaneous incisions. While endoscopicsurgery is a general term, “laparoscopic” and “thoracoscopic” describeendoscopic surgery within the abdomen and thoracic cavity, respectively.

As it is used in this description, “transmission line” generally refersto any transmission medium that can be used for the propagation ofsignals from one point to another.

Various embodiments of the present disclosure provide a port assemblyadapted to hold and/or control the movement and/or positioning of asurgical instrument inserted therethrough in conjunction with anendoscopic camera. Embodiments of the presently-disclosed port assemblymay be suitable for use in laparoscopic procedures as well as otherminimally-invasive surgical procedures, for example.

Various embodiments of the present disclosure provide a port assemblywherein control of the movement and/or positioning of a surgicalinstrument inserted therethrough may be performed manually orautomatically depending on the preference of the surgeon. In someembodiments, the surgical instrument or an endoscopic camera may beprovided with a user interface including one or more user-actuablecontrols and a wireless transmitter to provide a communicative linkbetween the user interface and the port assembly, e.g., to allow thesurgeon to change the position and/or orientation of the surgicalinstrument inserted through the port assembly.

During minimally-invasive surgical procedures, the working end of aninstrument is frequently located near the anatomical structure ofinterest and/or the surgical site within the working envelop. In someembodiments, wherein automatic control is employed for controlling themovement and/or positioning of an endoscopic camera or instrument, asensor and/or transmitter may be disposed in association with theworking end of an instrument, e.g., located on the tip of theinstrument, and the endoscopic camera may be automatically controlled to“track” the movement of the instrument tip (e.g., align the field ofview of the camera with the working end of the instrument) based on oneor more signals outputted by the sensor and/or transmitter. In someembodiments, the sensor and/or transmitter may include an attachmentmechanism, e.g., an adhesive backing, to allow the surgeon toselectively position the sensor and/or transmitter on a particularinstrument and/or at a particular location on a select instrument, e.g.,depending on surgeon preference, the type of surgery, etc.

Some examples of instruments used in minimally-invasive proceduresinclude staplers, graspers, cutters, forceps, dissectors, sealers,dividers, and other tools suitable for use in the area of the anatomicalstructure of interest. The instrument may be a standalone tool suitablefor use within a body cavity or external to the patient's body cavity.

In some embodiments, the controls may include an attachment mechanism,e.g., an adhesive backing, to allow the physician to selectivelyposition the controls on a particular instrument and/or at a preferredlocation on a select instrument. In some embodiments, the capability maybe provided to interface with an existing operating-room managementsystem, e.g., using speech recognition technology, to control one ormore settings of operating-room equipment. In some embodiments, the portassembly may be a standalone tool that interfaces with any suitableendoscopic camera.

The present disclosure includes a surgical system 5, which includes asurgical instrument 10, a port assembly 100, an endoscopic camera 200,and/or a control mechanism 300.

FIG. 1 illustrates surgical instrument 10 inserted through an embodimentof port assembly 100 according to the present disclosure. A distalportion of surgical instrument 10 is shown within tissue “T” (e.g.,adjacent a surgical site). A distal portion of an endoscopic camera 200is also shown positioned within the tissue “T.” Endoscopic camera 200 ispositioned such that endoscopic camera 200 can view a distal portion ofsurgical instrument 10 within the tissue “T.”

In FIG. 1, an embodiment of surgical instrument 10 is shown for use withvarious surgical procedures and generally includes a housing assembly20, a handle assembly 30, and an end-effector assembly 22. Surgicalinstrument 10 includes a shaft 12 that has a distal end 16 configured tomechanically engage the end-effector assembly 22 and a proximal end 14configured to mechanically engage the housing assembly 20. End-effectorassembly 22 generally includes a pair of opposing jaw assemblies 23 and24 pivotably mounted with respect to one another. In variousembodiments, actuation of a movable handle 40 toward a fixed handle 50pulls a drive sleeve (not shown) proximally to impart movement to thejaw assemblies 23 and 24 from an open position, wherein the jawassemblies 23 and 24 are disposed in spaced relation relative to oneanother, to a clamping or approximated position, wherein the jawassemblies 23 and 24 cooperate to grasp tissue therebetween. AlthoughFIG. 1 depicts a particular type of surgical instrument 10 (e.g., anelectrosurgical forceps) for use in connection with endoscopic surgicalprocedures, port assembly 100, endoscopic camera 200, and controlmechanism 300 may be used with a variety of instruments, e.g., dependingon the type of surgery.

In some embodiments, as shown in FIG. 1, the port assembly 100 iscoupled to a holding member 150. Holding member 150 may be adapted to beattachable to a table to provide support for the port assembly 100,e.g., to provide additional stability and/or reduce the weight of thetool on the patient's body.

When a powered surgical instrument is being used, it is envisioned thata transmission line operably connects the surgical instrument 10 to anelectrosurgical power generating source 28. Surgical instrument 10 mayalternatively be configured as a wireless device or battery-powered.Surgical instrument 10 may include a switch 65 configured to permit theuser to selectively activate the surgical instrument 10. When the switch65 is depressed, electrosurgical energy is transferred through one ormore electrical leads (not shown) to the jaw assemblies 23 and 24, forinstance.

In some embodiments, as shown in FIG. 1, the surgical instrument 10includes a user interface 140, which may be adapted to provide awireless (or wired) communication interface with the control mechanism300 of the surgical system 5. Additionally, or alternatively, thesurgical instrument 10 may include a sensor and/or transmitter 141,e.g., disposed in association with the end effector assembly 22, orcomponent thereof, e.g., jaw assembly 23. Further, the user interface140 may be associated with the endoscopic camera 200, for example.

User interface 140 may be disposed on another part of the surgicalinstrument 10 (e.g., the fixed handle 50, etc.) or another location onthe housing assembly 20. User interface 140 may include one or morecontrols (e.g., two controls 142 and 143 shown in FIG. 1), which mayinclude a switch (e.g., push button switch, toggle switch, slide switch)and/or a continuous actuator (e.g., rotary or linear potentiometer,rotary or linear encoder). In some embodiments, the user interface 140includes a first control (e.g., control 142) adapted to transmit signalsindicative of user intent to effect movement of the end effectorassembly 22 within the body cavity. User interface 140 may additionally,or alternatively, include a second control (e.g., control 143) adaptedto transmit signals indicative of user intent to adjust the tilt angleof the shaft 12.

Further details of a control mechanism, various sensors, and controlinterfaces are disclosed in U.S. Pat. No. 8,641,610, which issued onFeb. 4, 2014, the entire contents being incorporated by referenceherein.

In disclosed embodiments, a multi-functional sensor 210 is disposed inassociation with a distal portion of endoscopic camera 200. In someembodiments, multi-functional sensor 210 provides illumination andhouses a camera chip. It is to be understood that other sensorembodiments may be utilized. Sensor 210 is operably coupled to a powersource (e.g., power supply 312 shown in FIG. 1) via a transmission line310 coupled to the endoscopic camera 200. Wireless transmission of datafrom sensor 210 is also contemplated by the present disclosure.

With particular reference to FIGS. 2-5, port assembly 100 generallyincludes a body 110 and a control interface 160. Body 110 includes anexterior surface 112, an interior surface 114, and an interior space 116defined by the interior surface 114. In FIGS. 1, 2, 4 and 5, theexterior surface 112 of the body 110 is shown disposed in sealablecontact with tissue “T” at an entry site into the patient's body cavity.Body 110 of port assembly 100 is adapted to allow access into the bodycavity, e.g., to allow access of at least one surgical instrument 10through interior space 116, and may include at least one sealing elementor mechanism (not explicitly shown in the interest of clarity) to sealthe opening into the body cavity in the presence and/or absence of asurgical instrument 10, e.g., to help prevent the escape of insufflationgas. Body 110 may be formed of any suitable material such as a metal,plastic, alloy, composite material or any combination of such materials,for example.

Control interface 160 includes a plurality of inflatable members 180(e.g., inflatable members 180 a-180 i shown in FIG. 2) coupled to, orotherwise disposed in association with, the body 110 of port assembly100.

Each inflatable member 180 is inflatable and deflatable to apply a force(e.g., perpendicular to a longitudinal axis “A” defined by body 110) toa portion of the elongated shaft 12 of the surgical instrument 10 (i.e.,when the elongated shaft 12, or portion thereof, is disposed within theinterior space 116 as shown in FIGS. 1 and 3-5) to move the elongatedshaft 12 and/or end effector assembly 22 of the surgical instrument 10to a desired position within the body cavity, for example. As shown inFIG. 1, a portion of the elongated shaft 12 may be disposed within theinterior space 116 of the body 110 of the port assembly 100, while theend effector assembly 22 is disposed within the body cavity.

Control interface 160 is adapted to controllably move and/or positionthe elongated shaft 12 of the surgical instrument 10 to effect movementof the end effector assembly 22 within the body cavity. In disclosedembodiments, the control interface 160 is adapted to receive signalsfrom control mechanism 300 (which is schematically illustrated in FIG.1). Based on the signals received from the control mechanism 300, thecontrol interface 160 may adjust the spatial aspects of the surgicalinstrument 10 (e.g., by causing inflation/deflation of at least oneinflatable member 180) and/or perform other control functions, alarmingfunctions, or other functions in association therewith. Some examples ofspatial aspects associated with the surgical instrument 10 that may beadjusted include tilt angle of the elongated shaft 12 relative tolongitudinal axis “A,” and rotation of the elongated shaft 12 about alongitudinal axis “B” defined by the elongated shaft 12.

Inflatable members 180 are disposed in mechanical cooperation with theinterior surface 114 of the body 110 of the port assembly 100. Indisclosed embodiments, each inflatable member 180 is independentlycontrollable with respect to the other inflatable members 180. Here,each inflatable member 180 is in fluid communication with an inflationmedium 190 via a conduit 182. (For clarity, FIG. 1 illustrates threeconduits 182, but any number of conduits 182 may be included, such asthe same number of inflatable members 180). Inflation medium 190includes any suitable gas (e.g., oxygen, etc.) or fluid (e.g., water orsaline) that can be transferred to and from inflatable members 180 ofthe port assembly 100.

The amount, shape, size, arrangement, and orientation of inflatablemembers 180 are not limited by the examples shown in the accompanyingfigures. Rather, any amount, shape, size, arrangement, and orientationof inflatable members 180 are contemplated by the present disclosure.

In the embodiment illustrated in FIG. 2, port assembly 100 includes nineinflatable members 180 a-180 i associated therewith. The inflatablemembers 180 a-180 i of the illustrated embodiment include a first,proximal row of three inflatable members 180 a-180 c radially disposedabout interior surface 114 of the body 110, a second, middle row ofthree inflatable members 180 d-180 f radially disposed about interiorsurface 114 of the body 110, and a third, distal row of three inflatablemembers 180 g-180 i radially disposed about interior surface 114 of thebody 110. As noted above, the amount, shape, size, arrangement, andorientation of inflatable members 180 are not limited by theaccompanying figures. For example, more or fewer inflatable members arecontemplated by the present disclosure.

Each inflatable member 180 a-180 i includes a respective conduit 182a-182 i (FIG. 2) fluidly linking the inflatable member 180 a-180 i tothe inflation medium 190. It is envisioned that inflation medium 190 isstored in individual storage containers (e.g., one storage container foreach conduit 182 a-182 i), or that the inflation medium 190 is stored ina single storage container, and that each conduit 182 a-182 i includes avalve for controlling the amount of inflation medium 190 that can travelbetween the conduit 182 a-182 i and the respective inflatable member 180a-180 i.

In use, endoscopic camera 200 is configured to view at least a portionof the end effector assembly 22 of the surgical instrument 10 within thebody cavity. The sensor 210 is configured to store and/or relayinformation regarding the precise orientation and positioning of the endeffector assembly 22 (e.g., the degree tilt of the shaft 12 with respectto the longitudinal axis “A,” and the amount of rotation of the endeffector assembly 22 about the longitudinal axis “B”) within the bodycavity with respect to the endoscopic camera 200. The sensor 210 is alsoconfigured to compare the current orientation and positioninginformation of the end effector assembly 22 with stored (e.g., initial,optimal, user-defined, etc.) orientation and positioning information.

The sensor 210 is further configured to communicate the orientation andpositioning information of the end effector assembly 22 with controlmechanism 300 including a controller. Moreover, the sensor 210 isconfigured to communicate the difference between the current orientationand positioning of the end effector assembly 22 with the stored (e.g.,initial) orientation and positioning information. The control mechanism300 is configured to distribute the inflatable medium 190 to theappropriate inflatable member(s) 180 in order to move the shaft 12 ofthe surgical device 10 to re-orient the end effector assembly 22, suchthat the end effector assembly 22 moves to its stored (e.g., initial)orientation and position. For example, and with particular reference toFIG. 5, to tilt the end effector 22 with respect to the longitudinalaxis “A” in the general direction of arrow “C,” inflatable members 180 aand 180 i could be inflated and/or inflatable members 180 c and 180 gcould be deflated. (Inflatable members 180 b, 180 e and 180 h are notshown in FIG. 5 due to the particular cross-sectional view illustrated.)

Additionally, it is envisioned that rotation of the elongated shaft 12about the longitudinal axis “B” could be accomplished by sequentialinflation and/or deflation of adjacent inflatable members 180 (e.g.,inflatable members 180 that are axially-aligned and radially-adjacent).For instance, rotation of the elongated shaft 12 may be accomplished byfirst inflating inflatable member 180 a a certain amount (e.g., by aparticular volume and/or a particular duration) while deflatinginflatable member 180 b, then inflating inflatable member 180 c whiledeflating inflatable member 180 a, then inflating inflatable member 180b while deflating inflatable member 180 c. Additionally, it isenvisioned that radially-aligned and axially-offset inflatable members(e.g., 180 a, 180 d and 180 g; 180 b, 180 e and 180 h; and 180 c, 180 fand 180 i) can be inflated and/or deflated concurrently to facilitaterotation of the elongated shaft 12 about longitudinal axis “B.”

It is envisioned that a user is able to set various parameters using thecontrol mechanism 300. For example, it is envisioned that a user is ableto set an initial orientation and position of end effector assembly 22(e.g., after end effector assembly 22 is desirably positioned within thebody cavity) via touch screen or pressing a button on the surgicaldevice 10 and/or the control mechanism 300, for example. It is furtherenvisioned that a user can select whether the control mechanism 300changes the orientation and position of the end effector assembly 22continuously (i.e., continuously ensuring the current orientation andposition of the end effector assembly 22 matches the initial orientationand position), intermittently (i.e., changing the orientation andposition of the end effector assembly 22 after a given amount of time,if necessary, such that the current orientation and position of the endeffector assembly 22 matches the initial orientation and position),based on amount of movement of the end effector assembly 22 from itsinitial position (i.e., changing the orientation and position of the endeffector assembly 22 after the end effector assembly 22 has moved apredetermined amount from its initial position), and/or at user-definedtimes (e.g., after removal and re-insertion of the surgical instrument10 or a different surgical instrument), for example.

It is further envisioned that control mechanism 300, or another portionof the surgical system 5, is configured to give feedback to a usercorresponding to a particular amount of change in position and/ororientation of the end effector assembly 22 of the surgical instrument10. For example, it is envisioned that surgical system 5 gives visual(e.g., illuminating a light), audible (e.g., producing a beeping sound),and/or tactile (e.g., causing a handle of the surgical instrument 10 tovibrate) feedback in response to the change of position and/ororientation of the end effector assembly 22 which exceeds apredetermined value. Upon receiving this feedback, the user may manuallyinstruct (e.g., by pushing a button) the control mechanism 300 toreposition the surgical instrument 10 back to its initial position andorientation, for example.

The present disclosure also comprises the inclusion of afriction-enhancing surface or coating on an instrument-engaging surface181 (see FIG. 3) of at least one (e.g., all) inflatable member 180. Itis envisioned that the friction-enhancing surface 181 is made from amaterial that is different from another portion of the inflatable member180. For example, a majority of each inflatable member 180 may be madefrom, and the friction-enhancing surface or coating may include.

In use, it may be desirable to insert and/or position the surgicalinstrument 10 when inflatable members 180 are at least partiallydeflated, and then to inflate necessary inflatable members 180 to helpsecure the location, position and orientation (e.g., initial position)of the surgical instrument 10.

System 5 of the present disclosure may include a storage device. Thestorage device may include a set of executable instructions forperforming a method of controlling surgical instruments using a portassembly 100 as described herein. In some embodiments, the system 5 alsoincludes a processing unit and/or a database. Further details ofexemplary processing units and databases are described in U.S. Pat. No.8,641,610, which has been incorporated by reference hereinabove.

The present disclosure also includes methods of controlling surgicalinstruments using system 5, or portions thereof, as described above. Itis to be understood that the features of the method provided herein maybe performed in combination and in a different order than presentedherein without departing from the scope of the disclosure.

The various embodiments disclosed herein may also be configured to workwith robotic surgical systems and what is commonly referred to as“Telesurgery.” Such systems employ various robotic elements to assistthe surgeon in the operating theater and allow remote operation (orpartial remote operation) of surgical instrumentation. Various roboticarms, gears, cams, pulleys, electric and mechanical motors, etc. may beemployed for this purpose and may be designed with a robotic surgicalsystem to assist the surgeon during the course of an operation ortreatment. Such robotic systems may include, remotely steerable systems,automatically flexible surgical systems, remotely flexible surgicalsystems, remotely articulating surgical systems, wireless surgicalsystems, modular or selectively configurable remotely operated surgicalsystems, etc.

The robotic surgical systems may be employed with one or more consolesthat are next to the operating theater or located in a remote location.In this instance, one team of surgeons or nurses may prepare the patientfor surgery and configure the robotic surgical system with one or moreof the instruments disclosed herein while another surgeon (or group ofsurgeons) remotely control the instruments via the robotic surgicalsystem. As can be appreciated, a highly skilled surgeon may performmultiple operations in multiple locations without leaving his/her remoteconsole which can be both economically advantageous and a benefit to thepatient or a series of patients.

The robotic arms of the surgical system are typically coupled to a pairof master handles by a controller. The handles can be moved by thesurgeon to produce a corresponding movement of the working ends of anytype of surgical instrument (e.g., end effectors, graspers, knifes,scissors, etc.) which may complement the use of one or more of theembodiments described herein. The movement of the master handles may bescaled so that the working ends have a corresponding movement that isdifferent, smaller or larger, than the movement performed by theoperating hands of the surgeon. The scale factor or gearing ratio may beadjustable so that the operator can control the resolution of theworking ends of the surgical instrument(s).

The master handles may include various sensors to provide feedback tothe surgeon relating to various tissue parameters or conditions, e.g.,tissue resistance due to manipulation, cutting or otherwise treating,pressure by the instrument onto the tissue, tissue temperature, tissueimpedance, etc. As can be appreciated, such sensors provide the surgeonwith enhanced tactile feedback simulating actual operating conditions.The master handles may also include a variety of different actuators fordelicate tissue manipulation or treatment further enhancing thesurgeon's ability to mimic actual operating conditions.

With reference to FIGS. 6-8, a surgical system, such as, for example, arobotic surgical system is shown generally as surgical system 1000 andis usable with surgical system 5, or portions thereof, of the presentdisclosure. Surgical system 1000 generally includes a plurality ofrobotic arms 1002, 1003, a control device 1004, and an operating console1005 coupled with control device 1004. Operating console 1005 includes adisplay device 1006, which is set up in particular to displaythree-dimensional images; and manual input devices 1007, 1008, by meansof which a person (not shown), for example a surgeon, is able totelemanipulate robotic arms 1002, 1003 in a first operating mode, asknown in principle to a person skilled in the art.

Each of the robotic arms 1002, 1003 is composed of a plurality ofmembers, which are connected through joints. System 1000 also includesan instrument drive unit 1200 connected to distal ends of each ofrobotic arms 1002, 1003. Surgical instrument 10 supporting end-effectorassembly 22 may be attached to instrument drive unit 1200, in accordancewith any one of several embodiments disclosed herein, as will bedescribed in greater detail below.

Robotic arms 1002, 1003 may be driven by electric drives (not shown)that are connected to control device 1004. Control device 1004 (e.g., acomputer) is set up to activate the drives, in particular by means of acomputer program, in such a way that robotic arms 1002, 1003, theirinstrument drive units 1200 and thus the surgical instrument 10(including end-effector assembly 22) execute a desired movementaccording to a movement defined by means of manual input devices 1007,1008. Control device 1004 may also be set up in such a way that itregulates the movement of robotic arms 1002, 1003 and/or of the drives.

Surgical system 1000 is configured for use on a patient 1013 lying on apatient table 1012 to be treated in a minimally invasive manner by meansof end-effector assembly 22. Surgical system 1000 may also include morethan two robotic arms 1002, 1003, the additional robotic arms likewisebeing connected to control device 1004 and being telemanipulatable bymeans of operating console 1005. A surgical instrument 10 (includingend-effector assembly 22; see FIGS. 7 and 8) may also be attached to theadditional robotic arm.

Reference may be made to U.S. Patent Publication No. 2012/0116416, filedon Nov. 3, 2011, entitled “Medical Workstation,” the entire content ofwhich is incorporated herein by reference, for a detailed discussion ofthe construction and operation of surgical system 1000.

Turning to FIGS. 7 and 8, surgical system 1000 includes a surgicalassembly 1300, which includes robotic arm 1002, an instrument drive unit1200 connected to robotic arm 1002, and surgical instrument 10 coupledwith or to instrument drive unit 1200. Instrument drive unit 1200 isconfigured for driving an actuation of end-effector assembly 22 ofsurgical instrument 10 and to operatively support surgical instrument 10therein. Instrument drive unit 1200 transfers power and actuation forcesfrom motors “M” to surgical instrument 10 to ultimately drive movementof cables that are attached to end-effector assembly 22, for example.

In use, a trocar shaft 1232 is moved between a pre-operative position,as shown in FIG. 7, and an operative position, as shown in FIG. 8. Inthe pre-operative position, a guide ring 1240 and end-effector assembly22 are coplanar. In the operative position, guide ring 1240 is locatedproximal to end-effector assembly 22.

Although embodiments have been described in detail with reference to theaccompanying drawings for the purpose of illustration and description,it is to be understood that the inventive processes and apparatus arenot to be construed as limited thereby. It will be apparent to those ofordinary skill in the art that various modifications to the foregoingembodiments may be made without departing from the scope of thedisclosure.

What is claimed is:
 1. A surgical port assembly for use with surgicalinstruments, the surgical port assembly comprising: a body including anexterior surface and an interior surface, the interior surface definingan interior space, the interior space configured to allow a surgicalinstrument to pass therethrough; and a control interface including aplurality of inflatable members coupled to the body and inflatable toselectively apply a force to a portion of a shaft of the surgicalinstrument when the shaft is disposed within the interior space, whereineach of the plurality of inflatable members is independently selectivelyinflatable to move a distal portion of the surgical instrument to adesired position.
 2. The surgical port assembly according to claim 1,wherein at least one of the plurality of inflatable members isconfigured to apply a force to the surgical instrument in a directionperpendicular to a longitudinal axis of the body.
 3. The surgical portassembly according to claim 1, wherein at least one of the plurality ofinflatable members includes a friction-enhancing material.
 4. Thesurgical port assembly according to claim 3, wherein a majority of eachinflatable member is made from a first material, and wherein thefriction-enhancing material is different from the first material.
 5. Thesurgical port assembly according to claim 1, wherein the plurality ofinflatable members includes nine inflatable members.
 6. The surgicalport assembly according to claim 5, wherein the nine inflatable membersinclude a first set of three axially-aligned inflatable members, asecond set of three axially-aligned inflatable members, and a third setof three axially-aligned inflatable members.
 7. The surgical portassembly according to claim 5, wherein the nine inflatable membersinclude a first set of three radially-aligned inflatable members, asecond set of three radially-aligned inflatable members, and a third setof three radially-aligned inflatable members.
 8. A surgical system,comprising: a surgical port assembly including a body and a controlinterface, the body including an exterior surface and an interiorsurface, the interior surface defining an interior space, the interiorspace configured to allow a surgical instrument to pass therethrough,the control interface including a plurality of inflatable memberscoupled to the body and inflatable to selectively apply a force to aportion of a shaft of the surgical instrument when the shaft is disposedwithin the interior space, wherein each of the plurality of inflatablemembers is independently selectively inflatable to move a distal portionof the surgical instrument to a desired position; an endoscopic camera,a portion of the endoscopic camera being positionable within a bodycavity and configured to view the distal portion of the surgicalinstrument; and a control mechanism disposed in operative engagementwith the surgical port assembly and the endoscopic camera, the controlmechanism configured to control inflation and deflation of the pluralityof inflatable members.
 9. The surgical system according to claim 8,wherein the control mechanism is configured to control inflation anddeflation of each the plurality of inflatable members in response toinformation received from the endoscopic camera.
 10. The surgical systemaccording to claim 8, further comprising an inflation medium disposed influid communication with each of the plurality of inflatable membersindividually.
 11. The surgical system according to claim 10, wherein theinflation medium is disposed in operative communication with the controlmechanism.
 12. The surgical system according to claim 8, wherein atleast one of the plurality of inflatable members includes afriction-enhancing material.
 13. The surgical system according to claim12, wherein a majority of each inflatable member is made from a firstmaterial, and wherein the friction-enhancing material is different fromthe first material.
 14. The surgical system according to claim 8,wherein the plurality of inflatable members includes nine inflatablemembers.
 15. The surgical system according to claim 14, wherein the nineinflatable members include a first set of three axially-alignedinflatable members, a second set of three axially-aligned inflatablemembers, and a third set of three axially-aligned inflatable members.16. The surgical system according to claim 14, wherein the nineinflatable members include a first set of three radially-alignedinflatable members, a second set of three radially-aligned inflatablemembers, and a third set of three radially-aligned inflatable members.